Notice of Privacy Practices

This Notice describes how LocalMD Medical Center ("LocalMD," "we," "us," or "our") may use and disclose your protected health information (PHI) to carry out treatment, payment, and health care operations, and your rights regarding that information. This Notice applies to all of our locations, including Sunset Park, Brooklyn and Maspeth, Queens.

We are required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We reserve the right to change this Notice, and the revised Notice will apply to all PHI we maintain. An updated copy will be available upon request and on our website.

The following describes how we may use and disclose your PHI without your written authorization:

• Treatment: We may use and disclose your PHI to provide, coordinate, or manage your medical care. For example, we may share information with specialists, laboratories, or pharmacies involved in your care.
• Payment: We may use and disclose your PHI so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company, or a third party. For example, we may provide your health plan with information about a service you received so they will pay for it.
• Health Care Operations: We may use and disclose your PHI for practice operations, such as quality assessment, staff training, accreditation, licensing, and administrative activities that support our ability to provide care.
• Appointment Reminders: We may use and disclose your PHI to contact you as a reminder of an appointment for treatment or medical care.
• Treatment Alternatives: We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives.
• Health-Related Benefits and Services: We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.
• Individuals Involved in Your Care: We may disclose your PHI to a family member, friend, or other person involved in your care or payment for your care, to the extent permitted by law and consistent with your preferences.
• As Required By Law: We will disclose your PHI when required to do so by federal, state, or local law.

The following uses and disclosures of your PHI will be made only with your written authorization, which you may revoke at any time in writing:

Most uses and disclosures of psychotherapy notes (if we maintain them).

Uses and disclosures of your PHI for marketing purposes.

Disclosures that constitute a sale of your PHI.

Any other uses and disclosures not described in this Notice will be made only with your written authorization.

We may also use or disclose your PHI in the following circumstances, as permitted or required by law:

• Public Health Activities: To public health authorities for purposes such as reporting disease, births, deaths, child abuse or neglect, and adverse events.
• Health Oversight: To a health oversight agency for audits, investigations, inspections, and other activities necessary for oversight of the health care system and compliance.
• Lawsuits and Disputes: In response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process, as permitted.
• Law Enforcement: To law enforcement officials for specified law enforcement purposes, as required by law.
• Decedents: To a coroner, medical examiner, or funeral director as necessary to carry out their duties.
• Organ and Tissue Donation: To organizations involved in the procurement, banking, or transplantation of organs and tissues.
• Research: Under certain limited circumstances, for research that has been approved by an appropriate review process.
• To Avert a Serious Threat to Health or Safety: To prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• Workers' Compensation: As authorized by and to the extent necessary to comply with laws relating to workers' compensation.
• Specialized Government Functions: For specified government functions such as national security, military and veterans' activities, and protective services.

Under HIPAA, you have the following rights regarding your PHI:

• Right to Inspect and Copy: You may request to inspect or obtain a copy (paper or electronic) of your medical records and other PHI used to make decisions about your care. We may charge a reasonable, cost-based fee for copies.
• Right to Amend: You may request an amendment to your records if you believe they are inaccurate or incomplete. We may deny your request under certain circumstances, and you may submit a statement of disagreement.
• Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI (excluding disclosures for treatment, payment, operations, and other limited categories).
• Right to Request Restrictions: You may request a restriction or limitation on the PHI we use or disclose for treatment, payment, or operations, or to family members or others involved in your care. We are not required to agree to your request, except as required by law for disclosures to health plans of items or services paid in full out of pocket.
• Right to Request Confidential Communications: You may request that we communicate with you about your care in a certain way or at a certain location (for example, only by mail). We will accommodate reasonable requests.
• Right to a Paper Copy of This Notice: You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
• Right to Breach Notification: You have the right to be notified in writing following a breach of your unsecured PHI, in accordance with applicable law.

We are required by law to maintain the privacy and security of your PHI, to provide you with this Notice of our duties and privacy practices, and to follow the terms of the Notice currently in effect.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.

We will not use or disclose your PHI without your authorization, except as described in this Notice or as permitted or required by law.

If you believe your privacy rights have been violated, you may file a complaint with us and with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). You will not be penalized or retaliated against for filing a complaint.

To file a complaint with us, contact our Privacy Officer at either of our locations listed below. To file a complaint with the OCR, visit www.hhs.gov/ocr/privacy/hipaa/complaints or write to: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201. You may also call 1-877-696-6775 (toll-free).

If you have questions about this Notice, wish to exercise any of your rights, or would like to request a paper copy, please contact us:

• Sunset Park: 6219 5th Ave, Brooklyn, NY 11220 | (718) 475-0065
• Maspeth: 71-16 Grand Ave, Maspeth, NY 11378 | (718) 307-1577